Is Accurate Prediction of Gait in Nonambulatory Stroke Patients Possible Within 72 Hours Poststroke? The EPOS Study

J.M. Veerbeek, E.E.H. van Wegen, B.C. Harmeling-van der Wel, G. Kwakkel

    Research output: Contribution to JournalArticleAcademicpeer-review

    Abstract

    Background. Early prognosis, adequate goal setting, and referral are important for stroke management. Objective. To investigate if independent gait 6 months poststroke can be accurately predicted within the first 72 hours poststroke, based on simple clinical bedside tests. Reassessment on days 5 and 9 was used to check whether accuracy changed over time. Methods. In 154 first-ever ischemic stroke patients unable to walk independently, 19 demographic and clinical variables were assessed within 72 hours and again on days 5 and 9 poststroke. Multivariable logistic modeling was applied to identify early prognostic factors for regaining independent gait, defined as ≥4 points on the Functional Ambulation Categories. Results. Multivariable modeling showed that patients with an independent sitting balance (Trunk Control Test-sitting; 30 seconds) and strength of the hemiparetic leg (Motricity Index leg; eg, visible contraction for all 3 items, or movement against resistance but weaker for 1 item) on day 2 poststroke had a 98% probability of achieving independent gait at 6 months. Absence of these features in the first 72 hours was associated with a probability of 27%, declining to 10% by day 9. Conclusions. Accurate prediction of independent gait performance can be made soon after stroke, using 2 simple bedside tests: "sitting balance" and "strength of the hemiparetic leg." This knowledge is useful for making early clinical decisions regarding treatment goals and discharge planning at hospital stroke units. © The Author(s) 2011.
    Original languageEnglish
    Pages (from-to)268-274
    JournalNeurorehabilitation and Neural Repair
    Volume25
    Issue number3
    DOIs
    Publication statusPublished - 2011

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